Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003237991 |
---|---|
Provider Name | Vicki Goodman |
First Address | Provo, UT 84601-1547 |
Second Address | Provo, UT 84601-1547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2013 |
Last Update Date | 19/12/2013 |